Spousal Coverage Research Articles

The demand for preventive and restorative dental services among older adults.

Many older Americans have poor access to dental care, resulting in a high prevalence of oral health problems. Because traditional Medicare does not include dental care benefits, only older Americans who are employed, have post-retirement dental benefits or spousal coverage, or enroll in certain Medicare Advantage plans are able to obtain dental care coverage. We seek to determine the extent to which poor access to dental insurance and high out-of-pocket costs affect dental service use by the elderly. Using the 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices, we estimate a demand system for preventive dental services and basic and major restorative services. Selection into dental and medical insurance is addressed using a correlated random effects panel data specification. Consistent with prior studies of the nonelderly population, dental service use was not sensitive to out-of-pocket prices. However, private dental insurance increased preventive service use by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%, respectively. The use of services was more responsive to dental insurance for women than men. These estimates suggest that a Medicare dental benefit could significantly increase dental service use by older Americans.

Effects of health insurance on labour supply: a systematic review

PurposeThe purpose of this paper is to provide a systematic review of empirical evidence on the labour market effects of health insurance from the supply side.Design/methodology/approachThe study covers the largest peer-reviewed and working paper databases for labour economics and health studies. These include Web of Science, Google Scholar, Pubmed and the most popular economics working paper sources such as NBER, ECONSTOR, IDEAS, IZA, SSRN, World Bank Working Paper Series. The authors follow the PRISMA 2009 protocol for systematic reviews.FindingsThe collection includes 63 studies. The outcomes of interest are the number of hours worked, the probability of employment, self-employment and the level of economic formalisation. The authors find that the current literature is vastly concentrated on the USA. Spousal coverage in the USA is associated with reduced labour supply of secondary earners. The effect of Medicaid in the USA on the labour supply of its recipients is ambiguous. The employment-coverage link is an important determinant of the labour supply of people with health problems and self-employment decisions. Universal coverage may create either an incentive or a disincentive to work depending on the design of the system. Finally, evidence on the relationship between health insurance and the level of economic formalisation in developing countries is fragmented and limited.Practical implicationsThis study reviews the existing literature on the labour market effects of health insurance from the supply side. The authors find a large knowledge gap in emerging economies where health coverage is expanding. The authors also highlight important literature gaps that need to be filled in different themes of the topic.Originality/valueThis is the first systematic review on the topic which is becoming increasingly relevant for policy makers in developing countries where health coverage is expanding.

Young adult dependent coverage: were the state reforms effective?

To examine the robustness of findings regarding state-level adult dependent coverage expansions using detailed outcomes that specify coverage source. This study uses the 2001-2009 files of the Current Population Survey's Annual Social and Economic Supplement, covering calendar years 2000-2008, and considers young adults ages 19 through 29. Difference-in-differences methods were used to estimate the effect of state-level dependent coverage expansions on finely detailed categories of coverage, and falsification tests were used to evaluate the models themselves. Certain published results on state-level parental coverage expansions are flawed, with reported increases driven by changes in spousal coverage. Other published results appear to be in fact driven by parental coverage, but they are not robust to alternative model adjustments. This study shows evidence that one study's results on "dependent" coverage are in fact driven by changes in rates of spousal coverage. Results from a second study, though not robust to use of a more conventional DD model, would seem to apply most strongly to individuals at ages at which one would typically have lost parental coverage before reform, consistent with a "passive" effect rather than an "active" effect that enrolls previously uninsured youths.

Source of Health Insurance Coverage and Employment Survival Among Newly Disabled Workers: Evidence from the Health and Retirement Study

The onset of a work-limiting disability sets in motion a sequence of events that for a growing number of workers ends in early retirement from the labor force, SSDI application and, ultimately, long-term program participation. Exactly how this sequence of events plays out is not well understood. While there exist large bodies of literature that address the effects of health insurance coverage on a wide range of outcomes, few papers have sought to examine how source of health insurance coverage generally and employer sponsored health insurance (ESHI) specifically affect the employment trajectory following onset of disability. The authors use the nationally representative, longitudinal data from the Health and Retirement Study (HRS) to observe individuals before and after they experience a self-reported work limiting disability. To estimate the effect of ESHI on labor supply and disability claiming, they compare individuals covered by ESHI with no other employer-sponsored option (i.e., spousal coverage) with individuals covered by ESHI but whose spouses are offered coverage from their own employer. They find evidence of an “employment lock” effect of ESHI only among the 20 percent of individuals whose disabilities do not impact their immediate physical capacity but are associated with high medical costs. They do not find any evidence of differential disability insurance application rates between those with ESHI and the comparison group. With the passage of the Affordable Care Act, there is concern that disability insurance applications may swell because the incentive to remain employed will diminish for disabled workers reliant on ESHI. Their results suggest that the availability of non-employment-based health insurance may cause disabled workers with high cost/low severity conditions to leave the workforce but it will not necessarily lead to increased disability insurance application among individuals with ESHI.

Employer-provided Health Insurance and Labor Supply of Married Women

This work presents new evidence on the relationship between husbands’ health insurance and wives’ labor supply. Several studies using cross-sectional data have suggested that spousal coverage reduces wives’ labor supply; however, these estimates potentially suffer from bias due to simultaneity of wives’ labor supply and husbands’ health insurance. This paper attempts to obtain consistent estimates by applying several panel data estimators to data from the National Longitudinal Survey of Youth. The estimates suggest that the negative relationship found in cross-sections results mainly from spousal sorting and selection; controlling for unobserved heterogeneity leads to a smaller estimated effect of spousal coverage on wives’ labor supply.

Employer-Provided Health Insurance and Labor Supply of Married Women

This work presents new evidence on the effect of husbands’ health insurance on wives’ labor supply. Previous cross-sectional studies have estimated a significant negative effect of spousal coverage on wives’ labor supply. However, these estimates potentially suffer from bias due to the simultaneity of wives’ labor supply and the health insurance status of their husbands. This paper attempts to obtain consistent estimates by using several panel data methods. In particular, the likely correlation between unobserved personal characteristics of husbands and wives – such as preferences for work – and potential joint job choice decisions can be controlled by using panel data on intact marriages. The findings, using data from the National Longitudinal Survey of Youth and the Current Population Survey, suggest that the negative effect of spousal coverage on labor supply found in cross-sections results mainly from spousal sorting and selection. Once unobserved heterogeneity is controlled for, a relatively smaller estimated effect of spousal coverage on wives’ labor supply remains.

Is employer-based health insurance a barrier to entrepreneurship?

The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of “entrepreneurship lock” by using recent panel data from matched Current Population Surveys. We use difference-in-difference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55–75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that “entrepreneurship lock” exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation.

Married Women’s Labor Supply and Spousal Health Insurance Coverage in the United States: Results from Panel Data

This paper investigates the effect of spousal insurance coverage on married women’s labor supply. This effect was hypothesized to be negative, since married women have an incentive to seek employment in jobs that will provide insurance when their husbands do not provide coverage. Panel data from the 1996–2004 Medical Expenditure Panel Surveys was used to control for the potential correlation between unobserved characteristics and spousal insurance. The findings suggest that spousal coverage does have a negative effect on married women’s labor supply, and that most of the reduction in labor supply seems to derive from shifts out of the labor force rather than between part-time and full-time work.

Is Employer-Based Health Insurance a Barrier to Entrepreneurship?

The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of entrepreneurship lock by using recent panel data from matched Current Population Surveys. We use difference-indifference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that entrepreneurship lock exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation.

Price and Spouse's Coverage in Employee Demand for Health Insurance

The decline in health insurance coverage over the last two decades is a matter of national concern. The vast majority of insured individuals under age 65 obtain this coverage from their employer or as a dependent of a family member with group-sponsored health insurance. Recent evidence suggests that the decrease in coverage among full-time workers has resulted not so much from declining employer offers but rather from reduced take-up. The reasons for this change in employee behavior are not yet understood. Resolving this question is important for public policy because the two most likely explanations - the rise in employee insurance premiums and the increase in spousal coverage over this period - have different policy implications. We pool data from five supplements to the Current Population Survey covering the period 1988-2001 to examine the roles of insurance price and spousal coverage in decisions to elect employer-based coverage. We estimate the demand for employer-based health insurance among eligible workers as a function of price (measured as employee's share of total premium costs), firm size, employee characteristics, labor force status of spouses and, among working spouses, coverage under own employer plans. We find that the decisions of eligible full-time wage and salaried married workers to elect coverage are significantly influenced both by the costs of their own plans and by whether their spouses are covered under their own employment-based plans. We also find that women are considerably more responsive than men to both cost and spouses' coverage. Our findings provide the first evidence that price matters in the take-up decisions of full-time married workers, and that part of the decline in take-up in recent years may be attributed to the increasing cost of insurance. This decline is also explained, however, by the increase in the proportion of full-time workers whose spouses are covered under their own employer plans. Whether this latter trend is itself an outcome of rising insurance price remains to be determined.